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General NPI Number Information
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NPI Number | 1619835204
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Entity Type | Organization
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Legal Business Name | CONVICTED COMEBACK
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 5955 W PEORIA AVE UNIT 5343
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City | GLENDALE
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State | AZ
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Zip | 85312-1015
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Country | US
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Telephone | 623-309-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 W PEORIA AVE UNIT 5343
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City | GLENDALE
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State | AZ
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Zip | 85312-1015
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Country | US
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Telephone | 623-309-0052
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Fax |
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Authorized Official
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Title or Position | CO FOUNDER
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Name | MS. KRISTIN KLINE
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Credential |
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Telephone | 623-309-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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